Canada,

Province of

(territorial division)

This is the information of (name of peace officer), (occupation), of in the said (territorial division), hereinafter called the informant, taken before me.

The informant says that he or she has reasonable grounds to believe

• (a) that (offence), a designated offence within the meaning of section 487.04 of the Criminal Code, has been committed;

• (b) that a bodily substance has been found

  • (i) at the place where the offence was committed,

  • (ii) on or within the body of the victim of the offence,

  • (iii) on anything worn or carried by the victim at the time when the offence was committed, or

  • (iv) on or within the body of any person or thing or at any place associated with the commission of the offence;

• (c) that (name of person) was a party to the offence; and

• (d) that forensic DNA analysis of a bodily substance from (name of person) will provide evidence about whether the bodily substance referred to in paragraph (b) was from that person.

The reasonable grounds are:

The informant therefore requests that a warrant be issued authorizing the taking from (name of person) of the number of samples of bodily substances that are reasonably required for forensic DNA analysis, provided that the person taking the samples is able by virtue of training or experience to take them by means of the investigative procedures described in subsection 487.06(1) of the Criminal Code and provided that, if the person taking the samples is not a peace officer, he or she take the samples under the direction of a peace officer.

Sworn to before me this day of , A.D. , at .

(Signature of informant)

(Signature of provincial court judge)